“What About Horse Valve Replacements?” Asks Joseph

I just received a very interesting question from Joseph about the different types of tissue heart valve replacements.

Joseph writes, “Have you ever heard of any surgeon using equine tissue valves for aortic valve replacement? In the 10 months of researching my aortic valve disease, I’ve not heard of EQUINE valves being implanted — not once. Can you provide some insight? Thanks, Joseph”

Animated Of ATS 3F Aortic Bioprosthesis Valve Video
ATS 3F Bioprosthetic Aortic Valve – Equine Tissue Valve

As Joseph suggests in his question, most discussions about tissue valve replacements focus on pig valves (porcine) or cow valves (bovine). However, an interesting fact is that equine tissue valves do exist. I recently learned a lot about horse valve replacements during a tour of a Medtronic assembly facility in Irvine, California. Medtronic manufactures an equine valve replacement known as the ATS 3f Aortic Biprosthesis valve replacement (shown above).

The valve leaflets of an ATS 3f device are developed from the pericardium (the sac surrounding the heart) of a baby horse. This manufacturing approach is somewhat similar to that of bovine valves – which utilize the pericardium of a baby cow. Alternatively, porcine valves use the actual structure of a pig.

ATS 3f Bioprosthesis

As for the surgical implantation of this particular horse valve replacement, it has been utilized by several surgeons since its commercial introduction in 2008.

  • Dr. Allan Stewart, MD, noted, “The ATS 3f Aortic Bioprosthesis is the only tissue valve that preserves the sinuses and restores native valve stress distribution and physiologic flow to the entire aortic root”.
  • Also… You may recall that this stentless device was implanted in the first two, robot-assisted aortic valve replacement surgeries.

I hope that helps Joseph (and perhaps you) learn a little more about horse valve replacements, also known as equine tissue valves.

Keep on tickin!

Adam Pick
Written by Adam Pick

Adam Pick is a patient, author of The Patient's Guide To Heart Valve Surgery and the founder of HeartValveSurgery.com.

To learn how Adam has helped millions of people with heart valve disease, watch Adam's video, subscribe to his free newsletter, or visit his Facebook, or Twitter pages.

  • Bob

    I think most people would be eager to know the performanace and the resilience of the equine valves. It’s nice to know it exists but more information on its characteristics will be helpful.

  • Jerry

    It would put a bit more gallop in his step, but I’d be worried about the trots.

  • Joy

    My aortic valve was replaced with the ATS 3f at the Austin Heart Hospital on 7/21/10 by Dr. John Oswalt. When he went over the various valve options with me, he pointed out that this one had been in use in Europe for around 8 years. Although that is not long enough to be sure it will perform as expected (15-20 years), so far it is doing well. He also indicated that there may also be some advantage to the stentless design – if I understood his explanation correctly, the stent can be where a valve fails when it does ultimately fail. So, not having a stent might be a good thing. I wish you the best with your research, Joseph. Thanks to Adam for this site & his book which helped me immensely in preparing for surgery.

  • Tom Brighi

    Thank Goodness I came across your blog on the ATS 3f Aortic Bioprosthesis (Horse valve replacement by Medtronic) and your interview with Dr. Allan Stewart. This valve and the fact that it showed so much promise in design, durability, and future replacement via trans-catheter procedure more than intrigued me. On 02/17/2011 I had heart surgery at St. Luke’s Episcopal Hospital in Houston TX to replace my aortic valve. Dr. James J. Livesay of the Texas Heart Institute performed the surgery and I chose the ATS 3F equine valve. On March 14th I had my first echocardiogram and it was spot on. No leakage, and as all the information I was able to get my hands on prior to my decision to use the ATS 3f Aortic Bioprosthesis stated, as close to a native valve as I could get. My Cardiologist, Dr. Andrew Civetello stated, “It is very difficult to tell the difference between a native valve and the ATS 3f”. I understand that there is no long-term data available, however, to this point I am satisfied with my choice

  • Becky Sandness

    As a cardiac surgery nurse I have a question regarding how the equine valves are obtained. Are these animals raised specifically for the use of their valves or is there some type of screening for obtaining their valves? We are interested in finding out more information on this subject. thank-you for your time.

  • B, Garcia

    I had my equine valve 3 weeks ago. I had been doing fine, but this week I have had my heart rate go up. Could caffeine affect my heart rate? I was not told what not to eat, I did start some therapy and was told to watch my heart rate and not let it go over 125. Has any one had these problems?

  • Kevin Hightower

    Caffiene is the most commmon stimulant and all stimulants raise the heart rate. I would not intake any sort of caffiene until you call your doctors office and find ask about your diet and about caffiene. If they did not tell you these things, If I were you I would call that Dr’s office immediately and ask those questions. God Bless.


  • SarahKing

    i was wondering if you can help I am doing about the horse’s heart in my course I was asking if you can give me some information about it for me

  • Ron Danaht

    I had the 3f put in, in Dec 09 I woke from the surgery feeling better than I had in years. Now hear we are feb/14 and my valve is leaking bad enough I can feel it. I go back to see my surgeon next week to see what is going on with it . I will update when I find out what is going on

  • Tom Brighi

    Sorry to hear about your issue… Hope you get some good news from your surgeon! I’m celebrating 3 years with my 3f today… Just got back from my Doc this morning and so far so good… Keep us posted on your condition and if there are any concerns with the 3f… Thought and prayers…

  • Pat DeBruce

    My Aortic Valve was replaced on July 16, 2014. I feel soooo much better! I do have an equine valve. I am grateful that one of the Creator’s wonders gave me the gift of life.

  • Beth

    I had the 3f valve put in March, 2012. It did not perform well in my case. There was very bad leakage and I just had it replaced with a bovine valve. My surgeon is one of the best in the country, so I have no doubt about his skill. I think there needs to be more study on the 3f valve.

  • crookedstick

    So where are you getting the “baby horses” to rip out their hearts?

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